Pilot Information Systems
Carving a Niche in Tailored Cost Containment Solutions

In a world where financial prudence is a necessity, the healthcare industry still struggles with the complexity and cost of identifying insurance overpayments. An intricate web of challenges, including limited data accessibility, manual claims processing, duplicate billing, and lack of specialized expertise, exacerbates the issue.

Pilot Information Systems has made it its mission to counter these challenges head-on, focusing particularly on the intricacies of medical claims processing and cost containment. Its flagship offering, the Overpayment and Recovery System (OaRS), is a testament to the company’s commitment to providing efficient, affordable, and customizable solutions to the healthcare industry.

Designed by a team of managed care experts, OaRS is more than a SaaS software; it’s an agile solution that evolves in stride with shifting market trends and regulations, bringing unprecedented speed and accuracy to the daily analysis and editing of claims uploads. More interesting is the software’s holistic approach that oversees the entire claims process, from the configuration of communications to the setup of systems. The result is an industry-leading tool that effectively streamlines complex challenges such as managing intricate claims, consolidating billing, and ensuring compliance.

OaRS administers industry-standard edits sourced from respected organizations such as the Centers for Medicare & Medicaid Services (CMS), the American Medical Association, and reliable third-party companies. However, Pilot charges only a fraction of what their competitors do for the same edits.

“Our unique selling point lies in the proprietary rules OaRS employs. These rules, specifically designed for the efficient management and detection of overpayments and editing errors, set OaRS apart in the medical claims processing space,” says Michael Gordon, president of Pilot Information Systems.

Many of Pilot Information Systems’ clients are small claims processing companies with minimal IT infrastructure that struggle with the daunting task of creating proprietary submission files required for their claims. To alleviate this issue, Pilot Information Systems adopts a distinctive approach by accepting uploads in any format provided by clients, as long as all of the essential data fields are included. OaRS then generates results tailored to the preferred format of the clients. This adaptable strategy effectively bridges the gap between diverse IT capabilities and the crucial need for efficient claims processing.

This commitment to client trust and cost containment also extends to its pricing model. Pilot Information Systems offers flexible month-to-month agreements with fixed monthly subscription fees without any tricky “evergreen” clauses. “We have a fixed price model that is based on client membership, not on the volume of edits we find. It also eliminates the need for long-term commitments and removes the uncertainty of variable costs typically tied to savings percentages—a common practice in the industry,” says Ken Wiens, Business Development, Pilot Information Systems.

Today, Pilot Information Systems’ OaRS exemplifies the transformative potential of innovative technology when coupled with profound industry knowledge. With its global reach and a track record of processing millions of edits, the software has firmly established itself as a frontrunner in the field. This remarkable success iterates the profound impact that can be achieved when expertise, innovation, and a steadfast commitment to client-centric solutions converge.